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No Shots! No Shots! How to Get a Shot Without a Needle

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YouTube / MrScall60

Let's face it: nobody likes getting shots. The main pain point is the needle—it's scary, it's pointy, and people are afraid of it (I'll admit, I'm no fan of needles myself). But there is another way! "Needle-free" injection technology allows many shots to go in with no needle at all. Here's how it works, and some video of needle-free tech in action...including in a Batman movie.

Kids Getting Shots Without Crying

We've all been around kids when it's time to get a shot—it's no fun. There's wailing, there's bargaining, and there's a futile attempt to make it fun by applying a cartoon-character bandaid at the end. But here's a video that blew my mind: here are kids in Cambodia receiving vaccinations from a needle-free device called the PharmaJet Stratis. And they are not freaking out in the slightest. The first two kids clearly know what shots are and aren't happy about them—until they get the shot, and then actually smile. Check this out:

How the Technology Works

There are various kinds of needle-free injectors out there and in development, but let's talk first about the Stratis device shown above, which is being advanced by PharmaJet in collaboration with PATH, a global health nonprofit organization based in Seattle. I've held the Stratis, and it feels like a medium-sized flashlight. A small-tipped disposable syringe containing the injectable vaccine (or other injectable pharmaceutical) is inserted by a health worker into the top end of the handheld injector. The injector is "powered" by an inner spring, which is preset to a specific level of compression by the manufacturer during production. The level setting depends on the type of disposable-syringe jet injector and the desired pressure and depth of delivery (for example, subcutaneous or intramuscular). In other words, some injections just need to get beneath the skin, others need to go deeper.

Photo courtesy of PATH/Patrick McKern

In the Stratis design, the spring is "charged" just by putting the device in its "Reset Station," a simple mechanical case. The Reset Station compresses the spring to the proper amount by pushing metal bars of varying lengths against it. There's no electricity involved. Once the device is charged, you literally just press a button to deliver the injection.

After pressing the button, the vaccine is delivered through a tiny opening in the tip of the syringe, roughly the width of a human hair. The pressure from the spring creates a "liquid needle" that pushes fluid through the skin, much like a regular needle minus the metal. Then the tip automatically disables, preventing reuse. This is actually a special feature because one big problem with a conventional needle and syringe is reuse and cross-contamination, which increase the risk of disease transmission between patients. By comparison, jet injector syringe tips eliminate the chance for reuse. Also, because there's no needle, there is no risk of accidental needle-stick injury for people giving the injections or disposing of sharps waste.

The Stratis was pre-qualified by the World Health Organization (WHO) this year, which means it can be purchased and used by the WHO, GAVI Alliance, and UNICEF for mass immunization efforts.

Needle-free injection has actually been around since the 1940s. If you were in the U.S. military before 1997, you probably got some shots with a multi-use nozzle jet injector, an earlier form of the technology that lacked the anti-cross-contamination features of today’s disposable-syringe jet injectors. A fictional version of the needle-free technology was also featured on Star Trek, where we know it as a hypospray.

Even Batman Uses Needle-Free Tech

Spoiler alert: if you haven't seen Batman Begins yet, this will spoil a plot point for you!

In the movie, the Scarecrow releases a toxin into Gotham's water supply. Batman has an antidote, which he delivers using a real-world technology. Specifically, Batman employs the needle-free Biojector 2000 system (yes, that's its real name), painted black and dressed up to look more Batman-ish.

The system includes a handheld delivery device, needle-free syringes containing the antidote (or vaccine, or what-have-you), and a CO2 cartridge to power the injection. In the video below, you see the syringes at 0:13, and the handheld injector near the end (partly out of frame), lying next to two syringes. This would actually be a practical way to deliver mass vaccinations to a city, while avoiding the issues of cross-contamination and needle sticks. Chalk one up for realism in comic book movies!

Even More Needle-Free Tech!

Jet injectors aren't the only way to get vaccines and similar medications into the human body—thermoresponsive gels and fast-dissolving tablets for sublingual (under the tongue) delivery are other promising needle-free technologies in the works, plus there are nasal sprays already in use (FluMist, anyone?).

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YouTube / thelostdisney
5 Fun Facts About Health, Toilets, Muppets, and Presidents
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YouTube / thelostdisney

We've been running a series about global health since August 2013. Here are five of the most interesting facts we've uncovered since then.

1. There is a "World Toilet Organization" Run By "Mr. Toilet"

Jack Sim goes by "Mr. Toilet." He left the business world to found the WTO—no, not that one, the World Toilet Organization—in 2001. Starting that year, Mr. Toilet declared November 19 "World Toilet Day," and since then has been on a mission to bring sanitation to people in developing countries.

I urge you to drop what you're doing and watch this short video about Mr. Toilet. Yes, he says "shit" a lot. And it's awesome.

In addition to founding the World Toilet Organization and establishing World Toilet Day, Mr. Toilet is working to convince the world to abandon flush toilets, because they waste water. Sim reminds us that flush toilets waste up to 22 liters of water every day. Something to think about next time you debate whether to "let it mellow."

Learn more in 5 Reasons World Toilet Day is Awesome.

2. The Seven Dwarfs Helped Fight Malaria

Disney made an animated film in 1943 called The Winged Scourge featuring the Seven Dwarfs. It was the first in a series of animated propaganda shorts dealing with public health issues, and the only to feature established Disney characters. I'll summarize this ten-minute video for you: mosquitoes transmit malaria, malaria is bad, so let's kill mosquitoes. With help from dwarves. (Snow White doesn't make an appearance.)

Note that around 0:45 in the video, we see that malaria is still established in the United States in the world map. Malaria wasn't eliminated in the U.S. until 1951.

Read more in 8 Surprising Facts About Malaria.

3. George Washington Had Tremendous Health Problems

"Life of George Washington—The Christian Death" by Junius Brutus Stearns, courtesy of the Library of Congress

George Washington is likely the founding father to have suffered from the widest variety of awful diseases, so let's review some of the worst things that happened to him. As a young man, Washington traveled to Barbados with his brother Lawrence in 1751, in an attempt to cure Lawrence of his TB with fresh air. The attempted cure failed, and George became infected with TB in the process. He also managed to pick up smallpox while in Barbados.

George Washington returned from Barbados only to come down with pleurisy, while his brother Lawrence died from TB. George also contracted malaria (see above), and later suffered from dysentery. He died at age 67 while being treated for a throat infection. The treatment involved bleeding him (32 ounces of blood removed—probably what actually killed him), making him gargle vinegar, inducing vomiting, and nearly suffocating him with a molasses/butter/vinegar potion.

Washington's struggle with disease was so epic that PBS produced an entire article describing and discussing his medical problems and how they might have been solved today. (They noted that he also suffered from diphtheria, quinsy, a carbuncle, pneumonia, and epiglottitis. Ouch. Oh yeah, and he lost his teeth to infection and decay, leaving him with just one remaining tooth upon inauguration as president. He lost that one too.)

Check our the history of presidential pain in 6 Awful Illnesses Suffered By US Presidents.

4. Cookie Monster Promotes Handwashing and Healthy Eating

In April 2013, Cookie Monster emphasized the importance of handwashing as part of an effort to promote sanitation work around the world. (2.5 billion people don't have access to toilets!) He granted an interview on the subject, conducted by the Impatient Optimists blog. Here's a snippet:

Impatient Optimists: We know you’re a cookie enthusiast. Can you tell us your cookie eating ritual?

Cookie Monster: Me cookie eating reputation precedes me. Of course me have ritual! First me wash hands. This part very important because it help keep me healthy. Me not sure exactly how long me wash, but me sing the ABCs slowly and when me get to Z, it time to rinse and then look out, om nom nom nom nom. Me also like to share me cookies with Elmo and Big Bird. Little known secret, a birdseed cookie is delicious.

Cookie Monster also famously sang in 2005 that "A Cookie is a Sometimes Food" in an effort to combat obesity. (In the song, various fruits are declared "anytime foods.") In this video, he struggles with the choice between fresh fruit and a delicious cookie:

Cookie Monster also tackled food issues with a 90s-style rap about healthy eating, complete with gold chains. "Nutrition, it really hip!" Me love it.

Read more in 13 Sesame Street Muppets That Make a Difference.

5. One Man Created Eight of the Most Common Vaccines

Image courtesy of Images from the History of Medicine

Although most people have never heard of him, Maurice Hilleman developed dozens of vaccines, including eight vaccines that you may have received. Hilleman developed vaccines for chickenpox, Haemophilus influenzae bacteria, hepatitis A, hepatitis B, measles, meningitis, mumps, and pneumonia (among many others). His vaccines saved millions of lives, and I've received a bunch of them myself! His obituary read, in part (emphasis added):

"Hilleman is one of the true giants of science, medicine and public health in the 20th century," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"One can say without hyperbole that Maurice has changed the world," he added.

... "If I had to name a person who has done more for the benefit of human health, with less recognition than anyone else, it would be Maurice Hilleman," Gallo said six years ago. "Maurice should be recognized as the most successful vaccinologist in history."

His obituary is well worth a read, including colorful lines like: "'Montana blood runs very thick,' [Hilleman] said later, 'and chicken blood runs even thicker with me.'" (He grew up on a farm and worked with chickens quite a bit in developing vaccines.) His story is also told in the book Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases.

Read more in 5 Things You Might Not Know About Vaccines.

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YouTube / ONE
How Missed Calls Amplify Farmers' Voices
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YouTube / ONE

This week, Farm Radio International (FRI) announced the results of an innovative poll covering thousands of farmers. The biggest surprise was the way farmers voted: by calling a phone number and hanging up.

The survey was conducted in Tanzania, where smallholder farms (small family farms) make up around 75% of all farm production. FRI, an international radio service that partners with local stations, wanted to poll those farmers in order to help make their voices heard by the Tanzanian government. But how do you reach thousands of tiny farms spanning a whole country? In the case of Tanzania, the answer was radio talk shows and basic cell phones.

Photo courtesy of ONE / Do Agric

The Power of Radio Talk Shows and Cell Phones

Across Tanzania, there are radio stations broadcasting talk shows aimed at farmers. Those programs are already popular for the people the survey aimed to reach, so FRI partnered with five radio stations in different regions across the country. The local presenters added discussion segments to their programs dealing with the poll issues.

Radio broadcasters concluded the poll segments by asking yes/no questions, then giving out phone numbers that voters could dial into. But people generally don't want to waste their cell phone minutes on a poll, so a clever solution came into play: just call the number, then hang up. The missed call is logged, and that log constitutes a vote. This system is called "Beep to Vote," and it's free for voters because the missed call doesn't incur charges for using cell phone minutes. For yes/no questions, there was one phone number for "yes" and another for "no." A total of 8,891 smallholder farmers participated.

In addition to the "Beep to Vote" yes/no questions, the poll included a multiple-choice question that most voters responded to using SMS. Voters texted a single character ("1" for the first option, "2" for the second, and so on) to a specified phone number, and those results were tallied by computer. In addition to the SMS voting method, farmers could opt to make a voice call to an automated system, listen to the five options, and press a number to indicate their choice. 4,372 people responded to the multiple-choice question. The system was also able to send SMS reminders to voters in case they voted for one of the poll questions, but not the others.

The data was crunched in realtime using a system made by Telerivet, so poll workers could watch as votes came in. The system also checked incoming phone numbers so each phone (which roughly equates to each voter, or household) could only vote once per question.

Photo courtesy of ONE / Do Agric

Why This Matters

From a technological perspective, this poll is a brilliant example of choosing the right technology for the job. If a similar poll were conducted targeting middle-schoolers in the United States, it's likely that technologies like YouTube videos and click-to-vote within the video would be used. But for these Tanzanian farmers, the prevalent technologies are radio and cell phones. By putting them together, in a near zero-cost way, FRI was able to collect data that could influence government policies, which in turn could change livesusing just cellphones and radio.

This poll was part of a campaign called Do Agric, focused on encouraging African leaders to invest more in agriculture, in order to improve farming (and in turn, daily life) in Africa. Here's a video about the program:

When the results were announced earlier this week, Tanzania's President Kikwete said, "Action on agriculture has to be today, not tomorrow!" The voices of 8,891 farmers reached the president's ears.

For more on the survey, check out FRI's page on methodology and results.

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